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11010039 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 876 MILLER AVE CONTRACTOR:GENMOR PLUMBING PERMIT NO: 11010039 OWNER'S NAME: LOUIE QUON C AND JENNIE C 2552 SEABOARD AVE DATE ISSUED:01/06/2011 C VER'S PHONE: 4082487890 SAN JOSE,CA 95131 PHONE NO:(408)855-8348 Li LICENSED CONTRACTOR'S DECLARATION � r �� BUILDING PERMIT INFO: BLDG ELECT PLUMB License C s Li,# �� A'A,. MECH r RESIDENTIAL COMMERCIAL Contracto��J�"' 11�IV' a__0 II I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:COPPER REPIPE OF ENTIRE UNIT&REPLACEMENT OF (commencing with Section 7000)of Division 3 of the Business&Professions SHOWER VALVE Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Valuation:$3000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:37541015.876 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FRO AST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section �- 9.18. Issued by: Date: �^ - Signature -Date-% OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date: Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I O r or ut ized agent: , N become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, ,ts,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION .sting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RTI N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: 6 PERMIT# OWNER'S NAME: �"Zj v`�✓t �p" PHONE# GENERAL CONTRACTOR:6Qti mor L BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL S TRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. t it I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/Carpeting Linoleum/Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 876 miller ave. DATE: 01/06/2011 REVIEWED BY: bobs. APN: BP#: *VALUATION: 1$3,000 q*PERMITTYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition / Repair PRIMARY SFD or Duplex PENTAMATION 1 RPFIX USE: I PERMIT TYPE: WORK Underfloor re-pipe, replace shower valve. SCOPE APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES Fixture or Trap 1BPFIXTURE 1 # $8 Re-Pipe Interior 1PRREPIPE 1 # $11 TOTALS: $19.00 I fc(:/r. Flan Ch,-c k Plumb.Plan Check 0.0 hrs $0.00 h. A,rm l F"Y' Plumb.Permit Fee: IPPERMIT o lwr lh(h. irFoh. F-1 _L_ Other Plumb Insp. 0.0 hrs $42.00 ticth.Ita.w. /°;:e f'lam"h NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (Fee Resolution 09-051 Ef. 7,,"1,,,'IJO FEE QTY/FEE MISC ITEMS Platt Chcc'lv F(ee: PC.'F ec, PME Plan Check: $0.00 Permit Still//. /isp Fee PME Unit Fee: $19.00 PME Permit Fee: $42.00 ("'o nsIrliCt1017 Tax '4c,nustii;cr Ret°icrw L=Cc': Work Without Permit? 0 Yes No $0.00 Planning F`C<>s: Travel Documentation Fee: ITRA VDOC $42.00 Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $104.50 $0.00 TOTAL FEE: $104.50 Revised: 12/07/2010 CITY OF CUPERTINO 6 ITEMS OF 13 PERMIT RECEIPT OPERATOR: patg COPY ## 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37541015.876 DATE ISSUED. . . . . . . : 01/06/2011 RECEIPT #. . . . . . . . . : BS000012414 REFERENCE ID # . . . : 11010039 SITE ADDRESS . . . . . : 876 MILLER AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LOUIE QUON C AND JENNIE C ADDRESS . . . . . . . . . . : 876 MILLER AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : GENMOR PLUMBING, INC CONTRACTOR . . . . . . . : GENARO MORALS LIC # 27101 COMPANY . . . . . . . . . . : GENMOR PLUMBING ADDRESS . . . . . . . . . . : 2552 SEABOARD AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 855-8348 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 3, 000. 00 1. 00 0.00 1. 00 0 .00 1BPFIXTURE NO OF FIXTURE 1.00 8 .00 0 .00 8 . 00 0 . 00 1BSEISMICR VALUATION 3, 000. 00 0 .50 0 . 00 0. 50 0 .00 1PPERMITFE FLAT RATE 1 . 00 42 .00 0.00 42 . 00 0 . 00 1PRREPIPE NO OF FIXTURE 1.00 11 .00 0 .00 11. 00 0 . 00 1TRAVDOC FLAT RATE 1. 00 42 . 00 0 . 00 42 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 104 .50 0.00 104 .50 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 106 SEWER & WATER 202 UNDERFLOOR PLUMBING 301 ROUGH PLUMBING 302 TUB & OR SHOWER 502 FINAL PLUMBING ENERGY 506 GAS TEST 507 FINAL PLUMBING 512 FINAL HANDI-CAP CITY OF 113 1 0o CITY OF CUPERTINO REPIPE/SEWER/MAIN SERVICE CUPERTINO PERMIT APPLICATION FORM APN# i Lt-5) ` 9 '-7 r Date: t Building Address: aI'^ "Mer Atile, . Owner's Name: (1�6N Lw l-e Phong Contractor• Phone#: �'— (�' Fax#: Contact: Phone�#� Sy� q 0 — 1 �W1 Y- Fax/e-mail: Contractor License #: �33aO Cupertino Business License#: Job Description: re pipe Elf aj,�r� U nL* afid. @I &,Jor ✓atl ve . Residential A Commercial ❑ Valuation a 1< Project Size: Counter CT Express ❑ Standard ❑ Large ❑ Major ❑ Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Z Green Building Points: Quantity . Fee ID Fee Description Fee Permit Type Group 1PCSEWER Commercial building P 1CPSS sewer/sanitary sewer 1BPREPIPE Commercial re-pipe per fixture P 1CPRP 1PGASCOM Commercial Gas Piping System P 1-4 Outlets 1BCBSC Cal Bldg Standards Commission B ALL PERMIT Fee TYPES 1BSEISMICOM Seismic Commercial P Revised 12/06/10